Friday, August 21, 2009

The Great American Heathcare Debate

Entering a clinic in the US for the first time many years ago, I was shocked to find that the very first office door that greeted me was labeled "Financial Consultant." Shocked is not too mild a word to use. I think my Wife was surprised by my reaction. I really found it offensive. She was just used to it.

Healthcare is a huge issue in the news right now, as one of the things that President Obama promised if he got into power was "universal healthcare." Because I come from a country with so-called "socialized medicine," I have been asked many times just recently about how healthcare works in Britain. This is hardly surprising, since opponents of the proposed plan have often said things like, "We don't want a system like Britain or Canada" as if this is a bad thing. Even my own Doctor, during a routine check-up, started quizzing me about whether I preferred the US or UK healthcare system. I told him that, although not perfect, the National Health Service in the UK did ensure that everyone, whether they could afford it or not, was covered. His response was that anyone in the US could get free treatment in hospital emergency rooms. I didn't get a chance to say what I really wanted to, that I thought it would be really nice if the poor didn't have to wait until it became an emergency. Those who cannot afford health insurance either put off treatment, often until it's too late, or fill emergency rooms with non-emergency cases, stretching those already overworked departments.

Criticism of the National Health Service, mostly unfounded, by American opponents of Obama's plan has had a surprising effect amongst the British. A British friend wrote to me, "4 million Brits twittered in defence of the NHS almost crashing it. The debate is happening here---Fox news found an MEP (not MP), who defended the American 'healthcare only for those who can afford it' system, to spout some hysterical rightwing piffle. It has had a dramatic effect---the conservatives have gone from a shoe in, to an even contest in a week." He was talking about the opinion polls comparing the incumbent Labour party with the Conservative Party.

Conservatives in the US have been raising a very noisy protest against the proposals. Past vice-presidential candidate Sarah Palin started talking nonsense about Obama creating "death-panels" of bureaucrats who would make life or death decisions about our nearest and dearest. While Obama and his supporters have talked about 47 Million people in the US being uninsured, there are people who deny those figures, mentioning illegal immigrants (who wouldn't be included in the count anyway), Millionaires (this includes property which people would have to sell if they needed healthcare) and people who are in the process of switching insurance. The figures are probably much worse, because poor people often take a gamble on health insurance, taking it out some years and not others.

The right-wing have also gotten many ordinary working people scared that they are going to lose their choice of coverage. In the UK, if you can afford it, you can take out insurance and be treated privately. However, if you cannot afford to do this, you're still covered. This is what's being proposed in the US. In fact people will have more choice, not less.

These scare tactics take advantage, I think, of a deep-rooted "take care of yourself" ethic in the US. Another friend of mine, this time in Canada, said, "They keep saying 'I don't want to be socialized' like public health care and caring about our neighbours is a bad thing." I think that not only is universal healthcare the right thing to do, especially for the richest country in the world, but it's short-sighted for individuals to only consider their own situation right now. What happens if you get laid-off from your job, or want to start your own small business? US healthcare is big business, and that is where I believe things go wrong. The health of our people is essentially an issue of infrastucture.

Do you still think the US healthcare system works just fine now? The World Health Organization would disagree.

What do you think? I'd love to hear from you.

23 comments:

cartoongoddess said...

I've seen enough from my friends and colleagues in both Canada and the UK to know that socialized medicine is great. Unless, of course, you have a life threatening condition that needs fixing immediately.

There's a greater need to stay healthy and practice preventative care. I think that scares Americans.

Graham said...

@cartoongoddess - Thanks for your comments! A while back, Britain had a Doctor shortage problem, which did indeed result in long wait times for treatment, at least by the NHS. However, that situation has dramatically improved. The two areas that are still a bit lacking are dentistry and psychiatry (again, we're talking about NHS, not private).

Preventative care seems to scare big business more than individuals, I think.

Sophie Nussle said...

Socialised medicine is the way to go. Britain is actually not the best example of it, though the NHS is a pretty efficient system all round. But take a look at the superior systems in France and Italy if you want to see both superlative medicine and universal coverage. No life threatening condition is allowed to develop there, they practice both good preventative medicine and good treatment. Their system has broad consensus on the left and the right. France has been reforming its system recently to make it more cost-effective, and it has become even better as a result.

Sophie Nussle said...

Oh - and Graham, Britain is very poor in maternity care and obstetrics where there are no complications - it is a byword in the rest of Europe. I'd never have a baby in the UK. I've known personally too many scare stories, and my gynecologist, who did an internship in the UK some years ago, is still trying to recover! But in all other areas, the NHS is very good. And it is exceptional in primary healthcare and in a few research areas, like eyes.

SiouxGeonz said...

When folks trying to improve their lot and work their way out of poverty lose their jobs because they can't miss more than two days without a note from a doctor... and that would cost minimum $60...
When this lady is in tears from the pain of a UTI that has to get to emergency proportions to be treated (a little hard to get the math homework done)...
... and then when you're charged more because you aren't affiliated with the organization that has struck up a little negotiated deal...
The *system* is flawed and not self-correcting. I can't speak for any other systems but this one is killing us.

Asha said...

Our system is profit-based, which is why it fails so miserably. There is no incentive to cure anyone. There is huge incentive to order costly treatment, however. And on the insurance side, their incentive is to avoid paying for care. No wonder we're in a mess.

In ancient China, wealthy households retained a family doctor who lived with them. They provided all meals, board, and they paid them a wage as long as the family was healthy. However, if a family member was sick, the doctor would not be paid until they were well again. This is a more proper incentive.

JM said...

The right wing has effectively stirred the pot on this for years and continues to mine the fear in the current (dare I call it) debate. There are enough people susceptible to this manipulation and fear mongering that progress here is seriously at risk. Let's hope we don't settle for the devil we know.

Pazcual said...

Well, since I don't know USA nor UK, it's very hard for me to give you an opinion about that. However, I can tell you that health system here in Colombia its very but very strange. Most public hospitals (that are few in comparative to other countries on the continent) here don't have the basic things, specially in villages that are in the middle of conflict zones or in places were the terrorist attacks are made. Doctors will take around 6 to 14 hours to help you -in public hospitals-, and only if you are bleeding out they might remember you need help. On the other hand, private are..well worst. If you don't have social security (or medicine, I don't know the correct expression, my mistake) be sure that they won't even look at you, you can be ALL DAY there and uh-uh buddy...nothing. If you have the SS then it might take them 3 hours to help you, but at least, they do it.
That bad is the public/social healthcare in Colombia, that only in my city, kids can die of simple diseases like a flu because they don't have social secure and doctors won't help. It's a tragedy to see that we pay taxes to the Government and I still haven't seen too much improvement on that particularly aspect.
However, and because I don't want to scare anyone, many citizens and organizations have start to demand health attention no matter what and they have found deep support on the organizations or foundations created by the Uribe government or the ones who are not in the government. But still, Colombia needs to improve a lot to be on the level of the countries of the continent, because it's simply disappointing that we pay taxes and no one see where the heck are they.

Greets,

Paz

P.S. I liked this post so I will do a research about it! :D

rahul said...

Great piece. I posted it on my friend's facebook wall. Thanks for sharing!

Graham said...

@Sophie Nussle - thanks so much for your contribution to this discussion! I appreciate your friends' comments on your Facebook page too.

Regarding your comments on maternity/obstetrics in the UK under the NHS, how recent is the information you have? I've found many areas of NHS medicine have improved in recent years. Certainly, this writer does not have any complaints:

Why I love Britain's socialized healthcare system

I know very little about the French and Italian systems, apart from the fact they rate high on the WHO's charts. What can you tell me about them?

@SiouxGeonz - what powerful examples of what's wrong with US Healthcare. Scary, because that's just part of it!

@Asha - I was aware of your example of the ancient Chinese system. It's a shame to see China way down on the WHO tables now.

I think you're right on that having a profit-based system is US healthcare's deadly flaw.

@JM - I have the same fears.

@Pazcual - Thanks for sharing your Columbian perspective. It does sound scary. But if you look at the WHO tables of healthcare, and Columbia actually comes higher than the US! I wonder if it's because the figures were last compiled in 2000 and things have changed since then?

@rahul - thanks for your support!

Yonmei said...

Graham, I'm a resident of the UK and Sophie is right - compared to other European countries, the UK's maternity/obstetrics system isn't good, though the NHS is striving to improve in this area as in others.

Of course the UK is better than the US, but that's not the benchmark that the NHS would look to - there's no point comparing a better system to a worse. The countries to emulate are the ones which do do better than the NHS in caring for pregnant women, babies, and post-natal care - for which you look at the maternal mortality/morbidity rates and the infant death rate. The UK is better than the US by those markers, worse than at least a dozen European countries.

Graham said...

@Yonmei - thanks so much for that information. Maternity/obstetrics in the UK was something I had no experience about, and despite asking on Twitter/Facebook, I couldn't find anyone apart from Sophie who could confirm what she was suggesting about this area. Searching on the Web yielded no useful results, although I suspect that this is because I was not looking for "maternal mortality/morbidity rates and the infant death rate."

I was not suggesting in my piece that the US used the NHS as a model for how it should operate, it was simply the frame of reference that I was familiar with. Not only that but the UK and Canadian systems have been specifically picked out for comparison by opponents of universal healthcare.

I'd still like some information about how the French and Italian systems.

Mary said...

Thanks for this valuable post. It is a much needed conversation.

Graham said...

Thank you too, @Mary - you have some interesting blogs too. You're being followed! :)

Carrie B said...

It really is all about money. Many doctor's offices do not accept Medicare or Medicaid currently as the contractual write-off is too high. Doctors have to see twice as many patients to make the same amount of money. I imagine this would be the same for national health care.

Great post!

Ian said...

Hi! Loved the post Graham. As someone who is currently unemployed, due to a number of medical conditions (all non-emergency), I know that if I lived in the US I would not be able to afford the treatment I need, in order to get better and return to work! The NHS is not perfect but at least I can get free and good quality healthcare here in the UK.

Also, people in the UK consider it to be OUR NHS, as it is funded by us and therefore, it is always top of the agenda for politicians who want to stay in office. Improvements are constantly being made.

British people might grumble about the NHS but we are also fiercely protective of it.

The very notion that a person can be denied non-emergency medical attention because they are poor is abhorrent to me! The misery this must cause.

Graham said...

@Carrie B - I am led to believe that Doctors' pay in the UK is a lot better than it was, say, 10 Years ago, when there were worries about Doctors abandoning the NHS for private work.

@Ian - You're exactly the type of person who falls between the cracks here in the US right now. How would you be expected to get healthy enough to get back to work if you were not able to get healthcare?

Tiffany Jarman Jansen said...

Great post! As an American, I am loving reading what little of your blog I've been able to check out so far. It is so interesting to see what others think of your country (I, myself don't think too highly of it, unfortunately). I'm living in the Netherlands where the healthcare system is truly fantastic! It makes no sense to me that a country so full of itself, thinking it's the greatest country in the world is still living in the stone ages when it comes to so many things... healthcare being one of them

Graham said...

Thanks for sharing your thoughts, @Tiffany. And your blog is great too. I love reading cross-cultural blogs!

Tarot cards said...
This comment has been removed by a blog administrator.
Tiffany Jarman Jansen said...

Thanks! I agree - cross-culture blogs are fascinating! What I'd really love is to find one written by a Dutch person living in the US. I find it so interesting to read your blog, for example and see how you and others perceive my home country.

Graham said...

@Tiffany - there has got to be a blog somewhere by a Dutch person living in the US. That would be cool. I have blogged in the past about a friend of mine who's from New Jersey, but is now living in England. It is fascinating talking with her.

American Cloggie said...

I'm sure there is too. Just gotta keep looking. I read your post on your reverse situation friend and just think that's so cool!